Name
Address
City, State, Zip
Phone
I am [ ] Petitioner [ ] Petitioner’s Attorney (Utah Bar #:______)
In the District Court of Utah
______Judicial District ______County
Court Address ______
In the matter of the adoption of
______
Adoptee / Verified Petition for Adoption of an Adult
______
Case Number
______
Judge
I am the petitioner and I want to adopt ______(name of adoptee),
who is an adult.
1. Utah has jurisdiction in this case. (Utah Code 78B-6-105).
2. The case is filed in this county because (Choose all that apply; at least one must apply.):
[ ] I reside in this county.
[ ] I am not a resident of this state and the proposed adoptee was born in this county.
[ ] The proposed adoptee resides in this county on the day on which this petition is filed.
[ ] A parent of the proposed adoptee resides in this county on the day on which the petition is filed.
3. The full name of the adult to be adopted (the “adoptee”) is:
First nameMiddle name
Surname on birth certificate
Married surname (if any)
4. The adoptee was born on ______(date).
5. The adoptee was born in ______(city, county and state, OR city and country).
6. The adoptee lives in ______(city, state).
7. The adoptee is not a vulnerable adult. (Utah Code 78B-6-117).
8. (Choose one.):
[ ] The adoptee is citizen or national of the United States.
[ ] The adoptee is not a citizen or national of the United States but is legally in the United States. (Attach written evidence from the United States Citizenship and Immigration Services showing that the adoptee was admitted into the United States for permanent residence, was admitted into the United States temporarily in one of the lawful nonimmigrant categories, or was legally paroled into the United States.)
9. The adoptee consents to this adoption.
10. The adoptee is (Choose one.):
[ ] not married.
[ ] married, and the adoptee’s spouse (Choose one.):
[ ] has waived
[ ] has not waived
in writing notice of the adult adoption proceeding.
11. I am:
[ ] not married.
[ ] not cohabitating in a relationship that is not a legally valid and binding marriage under Utah law.
[ ] married, and
[ ] my spouse consents to this adoption.
12. I was born on ______(date) and I am at least ten years older than the adoptee.
13. [ ] My spouse was born on ______(date) and is at least ten years older than the adoptee.
14. [ ] I ask the court to waive the requirement to provide notice of the adoption once ordered to the adoptee’s legal parents for the following reasons:
15. [ ] The adoptee’s name should remain the same as in paragraph 3 above.
[ ] The adoptee will take my family surname as the adopting parent, and therefore the adoptee’s name should be changed on the adoptee’s birth certificate to:
First nameMiddle name
New surname
Married surname (if any)
16. I ask the court to enter a decree declaring me to be the legal parent of
______(name of adoptee).
17. [ ] I ask the court to order that the adoptee’s birth certificate be amended to name me as the adoptee’s parent.
Signature ►Date / Printed Name
On this date, I certify that ______(name) who is known to me or who presented satisfactory identification, in the form of ______(form of identification), has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true.
Signature ►
Date / Printed name (Court Clerk or Notary Public)
Notary Seal
1001ADF Approved September 19, 2017 / Verified Petition for Adoption of an Adult / Page 4 of 4